Waiting list management practices for home-care occupational therapy in the province of Quebec, Canada

Raymond, Marie-Hélène; Demers, Louise; Feldman, Debbie Ehrmann

doi:10.1111/hsc.12195

Cited by 37 publications

(29 citation statements)

References 30 publications

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“…This reduction in variability may provide an explanation for how STAT was effective in reducing waiting time overall. This finding is important, as one of the criticisms of traditional waiting lists and triage systems is the risk that low priority patients are continually pushed down the list by those with higher priority ratings, sometimes to the point where they never get seen [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

Harding

Leggat

Watts

et al. 2018

BMC Med

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BackgroundLong waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system.MethodsA stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network.ResultsThe intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments.ConclusionsBroad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.

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Section: Discussionmentioning

confidence: 99%

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

Harding

Leggat

Watts

et al. 2018

BMC Med

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“…Development of PPTs implies a decision-making process to select criteria according to which patient prioritization will be decided [4]. Decisions about these criteria and development process of PPTs are often not standardized [33], and there is a lack of synthesis of evidence about what constitutes a PPT [34].…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators for Implementation of a Patient Prioritization Tool in Rehabilitation Settings

Déry¹,

Ruiz²,

Routhier³

et al. 2020

Preprint

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Introduction. Prioritization tools aim to manage access to care by ranking patients equitably in waiting list based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a patient prioritization tool in rehabilitation programs.Methods. We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on Consolidated Framework for Implementation Research.Results. Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes on patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process.Conclusion. This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers’ perspective.Contributions to the literatureMethods used in this study could be operationalized in future studies to investigate barriers and facilitators of the implementation of an innovative intervention in rehabilitation settings.We used a well-known implementation framework (CFIR) to classified the determinants of the implementation, which could help to compare the results with other similar studies in implementation science.The barriers and facilitators identified in this study are an important first step in the implementation process of a patient prioritization tool in rehabilitation programs.

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“…Wait times are a common consequence of limited access to healthcare services that are observed in a variety of rehabilitation settings such as homecare or community services [1][2][3][4], outpatient hospital-based departments [1,2,5] and rehabilitation centres [1,6]. Patients who experience excessive wait times can suffer significant consequences, such as an increase of pain and impact on function, and deterioration in quality of life [2,7].…”

Section: Introductionmentioning

confidence: 99%

“…Rehabilitation service users have complex needs characterize by several social and physical factors related to their needs for care. It could thus be a good strategy to help manage access to healthcare and more specifically rehabilitation services in a fair and equitable manner [4].…”

Section: Introductionmentioning

confidence: 99%

Untitled

2020

Int J Healthc Syst Eng

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Patient prioritization, which is the process of ranking in a certain order based on various criteria, might be a good strategy to help manage access to healthcare services in a fair and equitable manner. It implies a decision-making process about prioritization criteria, and diverges substantially across programs. This process should thus be performed using a rigorous process that considers the various needs of the patients and evaluates them in a valid and reliable manner using prioritization tools carefully designed. In such tools, the prioritization criteria are often not standardized, not evidence-based or only based on individual clinical judgment. There is a need to document the criteria in rehabilitation programs. The aim of our study is to use a group method to obtain a consensus about patient prioritization criteria in two rehabilitation programs. We performed a group consensus-seeking method, Technique for Research of Information by Animation of a Group of Experts aiming to select prioritization criteria, which combines an individual and a group phase. Experts of both programs selected 10 criteria during a group discussion to prioritize patients in their respective programs. A group consensus method could promote a shared decision-making process between stakeholders to develop a prioritization tool in rehabilitation settings.

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Waiting list management practices for home-care occupational therapy in the province of Quebec, Canada

Cited by 37 publications

References 30 publications

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

Barriers and Facilitators for Implementation of a Patient Prioritization Tool in Rehabilitation Settings

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